Anaesthesiology intensive therapy
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Inadvertent perioperative hypothermia complicates a large percentage of surgical procedures and is related to multiple factors. Strictly regulated in normal conditions (± 0.2°C), the core body temperature of an anaesthetised patient may fall by as much as 6°C, while a 2°C decrease is very common. ⋯ The reasons for this are said to include underlying changes in microcirculation, coagulation, immunology and an increase in the duration of action of most anaesthesia medications. As effective methods have been available for a number of years now, it is currently indicated to maintain intraoperative normothermia in order to minimise procedure-related risk and improve patient comfort.
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Anaesthesiol Intensive Ther · Oct 2012
ReviewAssessment of three minimally invasive continuous cardiac output measurement methods in critically ill patients and a review of the literature.
In this study we compared the accuracy of three continuous cardiac output (CCO) measurement methods, with intermittent transcardiopulmonary thermodilution (TPTD-CO) as the gold standard. The three studied CCO measurement methods were: uncalibrated peripheral pulse contour measurement (FCCO), calibrated central pulse contour measurement (PCCO), and CCO obtained by indirect Fick principle (NCCO). ⋯ These results indicate that in our patient population, CCO can be most reliably monitored by calibrated central pulse contour measurements. All other methods appeared less accurate, especially in situations of low SVRI.
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Anaesthesiol Intensive Ther · Jul 2012
ReviewPharmacokinetic-pharmacodynamic modelling of antibiotic therapy in severe sepsis.
The antibiotic treatment of severe sepsis poses an increasing challenge in ICU. The multidrug resistance and diverse pharmacokinetics of antibiotics requires a different approach on antibiotic therapy because of the inadequate serum antibiotic levels found in ICU patients. The current guidelines or recommendations of antibiotic treatment take into account the pharmacokinetic parameters in determining the proper dosage. The recommended antibiotic treatment of severe sepsis requires daily assessment and dosage adjustment based on measurements of antibiotic concentrations in order to optimize the treatment.
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Anaesthesiol Intensive Ther · Jul 2012
ReviewManagement of perioperative stress in children and parents. Part II--anaesthesia and postoperative period.
The majority of children, even those well prepared and with positive attitudes, experiences stress in the operating theatre and during the postoperative period. In some cases, the stress is even stronger for their parents. ⋯ Such a stress-reducing strategy should be initiated before hospitalisation and consistently continued to its completion or even longer, the example of which are one-day surgery patients who should receive prescriptions for or suitable drugs (mainly analgesics) on discharge for use in the home setting. Preparation of local programmes for management reducing surgery-associated stress in children is worth recommending.
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Anaesthesiol Intensive Ther · Apr 2012
ReviewAnaphylactic reactions during anaesthesia and the perioperative period.
Allergy and hypersensitivity occurring during anaesthesia remains a major cause of concern for anaesthesiologists. Drugs administered during surgery and various anaesthetic procedures can elicit two major groups of adverse reactions. The first group includes reactions that are usually dose-dependent and related to the pharmacological properties of a drug and/or its metabolites. ⋯ Multiple organ failure, beginning with bronchospasm and cardiovascular collapse, is typical of latex reactions. An increased serum tryptase concentration confirms the diagnosis of an anaphylactic reaction, and triggers can be identified by skin prick, intradermal injection, or serologic testing. The elimination of triggers during subsequent medical episodes is essential to avoid major mortality and morbidity.